At my home we keep about twenty chickens, and we lost a couple of them to predators a couple of weeks ago. As my wife and I were discussing the incident and possible causes for the demise of our egg-producers, one item on the differential diagnosis was “fox”. I’m told that coyotes might leave a residue of feathers, but that foxes will steal away the chicken without a trace. We had no sign of foul play near the chickens, so are working with the idea that there must be a fox nearby. This fox seems to have been taking chickens at will, without really caring about our attachment to the simple animals, nor caring about the omelets that we’ll be missing in the future.
Which brings me to pathology. I was in a recent discussion with a colleague about a hospital that outsources their blood bank and transfusion medicine operations. My colleague said that the contractor had no incentive to limit blood product useage. In fact, he suspected that their practices encouraged generous useage of blood products resulting in quite a bit of wastage. Which is then billed to the hospital. “It’s like the fox in the henhouse”, he said. I nodded in agreement. “That doesn’t sound right”, I replied. “Who would allow a setup where someone can make you pay for whatever they say that you need?”
And then I got to thinking about it. Frequently I read about the audacity of urologists/gastroenterologists/dermatologists who set up their own labs and pocket profits that would otherwise go to pathologists (see Dr Kaplan’s recent blog about Chicago and pathology at http://tissuepathology.com/2014/06/25/car-washes-crib-sheets-and-surgical-pathology-sleaze-graft-and-corruption/#axzz388XhjQE6).
By some reports, these labs overutilize some procedures. That sounds kind of like the fox in the henhouse.
And then I wondered about our general practice of pathology. Does it ever happen that one of us orders a stain that we really don’t need in order to make a diagnosis? Are there any pathology labs that routinely perform a Helicobacter stain (special or immuno) on all gastric biopsies? Do we ever end up causing extra expense to patients because of our lack of knowledge or experience?
The American public (and insurers) are getting smarter about what testing and treatment are indicated in many areas (don’t believe me? – check out this website – www.choosingwisely.org). We as a profession need to make sure that we don’t come across as foxes feasting on the proverbial hens.